Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer’s disease: Validation in a large memory clinic population

Claus, J. J.; Staekenborg, Salka S.; Holl, Dana C; Roorda, Jelmen J.; Schuur, Jacqueline; Koster, Pieter; Tielkes, Caroline E.M.; Scheltens, Philip

doi:10.1007/s00330-016-4726-3

Cited by 55 publications

(47 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…"after" (n = 125) from using VRS would be greater in this group [30,31]. It cannot be excluded that an older study population or a memory clinic population would have yielded a higher prevalence of abnormal findings where a different compliance with our template cannot be excluded.…”

Section: Discussionmentioning

confidence: 89%

Reporting frequency of radiology findings increases after introducing visual rating scales in the primary care diagnostic work up of subjective and mild cognitive impairment

et al. 2020

View full text Add to dashboard Cite

Objectives Study the effect of introducing a template for radiological reporting of non-enhanced computed tomography (NECT) in the primary care diagnostic work up of cognitive impairment using visual rating scales (VRS). Methods Radiology reports were assessed regarding compliance with a contextual report template and the reporting of the parameters medial temporal lobe atrophy (MTA), white matter changes (WMC), global cortical atrophy (GCA), and width of lateral ventricles (WLV) using established VRS in two age-matched groups examined with NECT before (n = 111) and after (n = 125) the introduction of contextual reporting at our department. True positive rate (TPR) and true negative rate (TNR) before and after were compared. Results We observed a significant increase in the percentage of radiology reports with mentioning of MTA from 29 to 76% (p < 0.001), WMC from 69 to 86% (p < 0.01), and GCA from 54 to 82% (p < 0.001). We observed a significant increase in the percentages of reports where all of the parameters were mentioned, from 6 to 29% (p < 0.001). There was a significant increase in TPR from 10 to 55% for MTA. Conclusion This study suggests that contextual radiological assessment using VRS could increase the reporting frequency of radiology findings in the diagnostic work up of cognitive impairment but compliance with templates may be difficult to endorse. Key Points • Introducing visual rating scales in clinical practice increases the reporting frequency of MTA, WMC, and GCA in the diagnostic work up of subjective and mild cognitive impairment. • Introducing visual rating scales has an effect on the true positive rate of reported MTA. • Compliance with contextual radiology templates remains low when use of the template is not enforced by the department leadership. Keywords Brain. Dementia. Tomography X-ray computed Abbreviations AD Alzheimer's disease BioFINDER Biomarkers for identifying neurodegenerative disorders early and reliably CI Confidence interval CSF spaces Cerebrospinal fluid spaces CT Computed tomography EI Evans' index GCA Global cortical atrophy HU Hounsfield units MRI Magnetic resonance imaging MTA Medial temporal lobe atrophy NECT Non-enhanced computed tomography PACS Picture archiving and communication system * Claes Håkansson

show abstract

Section: Discussionmentioning

confidence: 89%

Reporting frequency of radiology findings increases after introducing visual rating scales in the primary care diagnostic work up of subjective and mild cognitive impairment

et al. 2020

View full text Add to dashboard Cite

show abstract

“…While T1/T2 might affect atrophy ratings, a situation that the neuroradiologist is accustomed to and takes into account during ratings, field strength is not found to affect atrophy ratings [ 52 ]. Another MRI-related limitation was that the cut-offs used were based on only a single study, however, the cut-offs have been validated in several later studies [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

MRI-assessed atrophy subtypes in Alzheimer’s disease and the cognitive reserve hypothesis

et al. 2017

View full text Add to dashboard Cite

Background/AimsMRI assessment of the brain has demonstrated four different patterns of atrophy in patients with Alzheimer’s disease dementia (AD): typical AD, limbic-predominant AD, hippocampal-sparing AD, and a subtype with minimal atrophy, previously referred to as no-atrophy AD. The aim of the present study was to identify and describe the differences between these four AD subtypes in a longitudinal memory-clinic study.MethodsThe medial temporal lobes, the frontal regions, and the posterior regions were assessed with MRI visual rating scales to categorize 123 patients with mild AD according to ICD-10 and NINCDS-ADRDA criteria and the clinical dementia rating scale (CDR) into atrophy subtypes. Demographic data, neuropsychological measures, cerebrospinal-fluid biomarkers, and progression rate of dementia at two-year follow-up were compared between the groups.ResultsTypical AD was found in 59 patients (48%); 29 (24%) patients had limbic-predominant AD; 19 (15%) had hippocampal-sparing AD; and 16 (13%) belonged to the group with minimal atrophy. No differences were found regarding cognitive test results or progression rates between the different subtypes. Using adjusted logistic regression analysis, we found that the patients in the minimal-atrophy group were less educated, had a lower baseline CDR sum of boxes score, and had higher levels of amyloid β in the cerebrospinal fluid.ConclusionPrevious results concerning the prevalence and the similar phenotypic expressions of the four AD subtypes were confirmed. The main finding was that patients with minimal atrophy as assessed by MRI had less education than the other AD subtypes and that this could support the cognitive reserve hypothesis and, at least in part, explain the lower degree of atrophy in this group. Patients with less formal education might present with clinically typical AD symptoms before they have positive biomarkers of AD and this finding might challenge suggested biomarker-based criteria for AD.

show abstract

“…In a more-recent study that applied Scheltens' scale to computed tomography (CT) images, the authors suggested using cutoff scores of >1.5 for those aged <75 years and ≥2 for those aged >75 years. 19 In another study, Pereira et al 12 concluded that an MTA VRS score of ≥2 (in at least one hemisphere) was considered abnormal for subjects aged <75 years, whilst a score of ≥3 (in at least one hemisphere) should be considered abnormal for subjects aged >75 years. Our study findings of cutoff scores of ≥2 for those aged 70–79 years and ≥3 for those aged 80–89 years are comparable to both of these previous studies.…”

Section: Discussionmentioning

confidence: 99%

Age-Specific Cutoff Scores on a T1-Weighted Axial Medial Temporal-Lobe Atrophy Visual Rating Scale in Alzheimer's Disease Using Clinical Research Center for Dementia of South Korea Data

et al. 2018

View full text Add to dashboard Cite

Background and PurposeVisual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people.MethodsThe 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve.ResultsThe optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p<0.001).ConclusionsThese results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.

show abstract

Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer’s disease: Validation in a large memory clinic population

Cited by 55 publications

References 40 publications

Reporting frequency of radiology findings increases after introducing visual rating scales in the primary care diagnostic work up of subjective and mild cognitive impairment

Reporting frequency of radiology findings increases after introducing visual rating scales in the primary care diagnostic work up of subjective and mild cognitive impairment

MRI-assessed atrophy subtypes in Alzheimer’s disease and the cognitive reserve hypothesis

Age-Specific Cutoff Scores on a T1-Weighted Axial Medial Temporal-Lobe Atrophy Visual Rating Scale in Alzheimer's Disease Using Clinical Research Center for Dementia of South Korea Data

Contact Info

Product

Resources

About